Cleft Rhinoplasty: Strategies for the Multiply Operated Nose

AbstractRhinoplasty, as a surgical procedure to improve the appearance of the nose while preserving or improving function, is complicated and difficult to master. Revision cleft rhinoplasty offers another tier of challenge. The symmetry, proportions, and definition of the nose are affected by the native cleft deformity but also previous surgical scars, cartilage grafts, and skin excisions. Our preferred approach is to use structural cartilage grafting to establish septal and lower lateral cartilage resiliency. Internal lining deficiency is addressed with skin or lining transfer, while excess nasal tip thickness is contoured to improve definition. Of the utmost importance, the cleft nasal deformity cannot be considered in isolation, but rather a combined amalgamation of the lip muscle and scar, dentofacial occlusion, and skeletal maxillary deficiency.

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Lateral intercrural suture in the caucasian nose: Decreased domal divergence angle in endonasal rhinoplasty without delivery

International Archives of Otorhinolaryngology ◽

10.7162/s1809-97772012000200013 ◽

2012 ◽

Vol 16 (02) ◽

pp. 232-235

Author(s):

Marcos Mocelin ◽

Caio Soares ◽

Rogério Pasinato ◽

Andreia Frota ◽

Cezar Berger

Keyword(s):

Prospective Study ◽

Divergence Angle ◽

Lateral Cartilage ◽

Lower Lateral Cartilage ◽

Lateral Crus ◽

Basic Technique ◽

Nasal Tip ◽

Definition Of

Summary Introduction: Several techniques can be performed to improve nasal tip definition such as cartilage resection, tip grafts, or sutures. Objctive: To evaluate the outcome of lateral intercrural suture at the lower lateral cartilage by endonasal rhinoplasty with a basic technique without delivery in decreasing the angle of domal divergence and improving the nasal tip definition. Method: This prospective study was performed in 64 patients in which a suture was made on the board head of the lower lateral cartilage in the joint between the dome and lateral crus, using polydioxanone (PDS) with sharp, curved needle. Results: In all of the cases, better definition of the nasal tip was achieved by intercrural suturing for at least 6 months postoperatively. Conclusion: Lateral intercrural suture of the lower lateral cartilage provides improved nasal tip definition and can be performed by endonasal rhinoplasty without delivery in the Caucasian nose.

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Correction of Asian Short Nose with Lower Lateral Cartilage Repositioning and Ear Cartilage Grafting

Plastic & Reconstructive Surgery Global Open ◽

10.1097/gox.0b013e3182a85b29 ◽

2013 ◽

Vol 1 (6) ◽

pp. e45 ◽

Cited By ~ 11

Author(s):

Jin Suk Byun ◽

Kenneth K. Kim

Keyword(s):

Lateral Cartilage ◽

Lower Lateral Cartilage ◽

Short Nose ◽

Ear Cartilage ◽

Cartilage Grafting

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Correction of secondary unilateral cleft lip nasal deformity in adults using lower lateral cartilage repositioning, columellar strut, and onlay cartilage graft on the nasal tip with open rhinoplasty combined with reverse-U incision

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2020.10.060 ◽

2020 ◽

Author(s):

Byung Chae Cho ◽

Jeong Woo Lee ◽

Joon Seok Lee ◽

Jong Ho Lee ◽

Jeong Yeop Ryu ◽

...

Keyword(s):

Cleft Lip ◽

Open Rhinoplasty ◽

Lateral Cartilage ◽

Cartilage Graft ◽

Lower Lateral Cartilage ◽

Nasal Deformity ◽

Nasal Tip ◽

Columellar Strut

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Bilateral congenital aplasia of nasal lower lateral cartilage: a rare anomaly

BMJ Case Reports ◽

10.1136/bcr-2019-231905 ◽

2020 ◽

Vol 13 (1) ◽

pp. e231905 ◽

Cited By ~ 1

Author(s):

Kapil Soni ◽

Darwin Kaushal ◽

Bikram Choudhury ◽

Ranjit Kumar Sahu

Keyword(s):

Septal Cartilage ◽

Lateral Cartilage ◽

Lower Lateral Cartilage ◽

Difficulty Breathing ◽

Aesthetic Results ◽

Congenital Aplasia ◽

Grafting Through ◽

Cartilage Grafting ◽

External Rhinoplasty

Congenital nasal anomalies are rare and occur in 1/20 000–1/40 000 newborns. An 8-year-old boy presented with developmental aplasia of bilateral nasal lower lateral cartilages, with excessive wrinkled and loose skin on the dorsum of the nose and with difficulty breathing through the nose. This is probably the first such case to be reported in the literature. The defect was reconstructed using conchal and septal cartilage grafting through an external rhinoplasty approach. At the end of the 12-month follow-up period, the patient was found to be satisfied with the functional and aesthetic results of the operation. Bilateral congenital aplasia of nasal lower lateral cartilages is extremely rare. Paediatric rhinoplasty is imperative in such cases.

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Definitive Cleft Rhinoplasty for Unilateral Cleft Nasal Deformity

JAMA Facial Plastic Surgery ◽

10.1001/jamafacial.2015.2031 ◽

2016 ◽

Vol 18 (2) ◽

pp. 144-145

Author(s):

Myriam Loyo ◽

Tom D. Wang

Keyword(s):

Nasal Deformity ◽

Cleft Rhinoplasty ◽

Cleft Nasal Deformity

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Clincal Study on Surgical Correction of Cleft Nasal Deformity

Korean Cleft Lip and Palate Association ◽

10.31136/kjclp.2018.21.1.1 ◽

2018 ◽

Vol 21 (1) ◽

pp. 1-7

Author(s):

Young-Kee Lee ◽

◽

Young-Wook Park ◽

Keyword(s):

Surgical Correction ◽

Nasal Deformity ◽

Cleft Nasal Deformity

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The nasal cantilever technique in children undergoing primary cleft lip surgery: novel concepts and review

Innovative Surgical Sciences ◽

10.1515/iss-2020-0016 ◽

2020 ◽

Vol 5 (1-2) ◽

pp. 53-62

Author(s):

Badr M. I. Abdulrauf

Keyword(s):

Learning Curve ◽

Cleft Lip ◽

Nasal Bone ◽

Case Series ◽

Nasal Deformity ◽

Challenging Issue ◽

Primary Surgery ◽

Novel Concept ◽

Cleft Nasal Deformity

AbstractBackgroundNasal deformity associated with cleft lip deformity is a challenging issue, encompassing controversies, theories, and a diversity of techniques. Historically, esthetic outcomes have ranged from being below expectations to barely acceptable.MethodBased on the concept that the nasal cartilaginous framework in clefts is similar to that of a collapsing pyramid, a novel suspension technique has been described. The entire cartilaginous structure is lifted from the infratip segment with a loop suture and is secured in a cantilever fashion onto the periosteum overlying the nasal bone. This part of the operation is performed in a semiclosed manner. The technique is applied during primary surgery in bilateral and unilateral nasal cleft lip deformities, with changes in the orientation of the cantilever loop suture. Studies conducted by Masters S. Tajima, H. McComb, H. Thomson, D. Fisher, and J. Mulliken, which are most relevant to this article, have been reviewed and discussed throughout.ResultsThe technique was first applied over 10 years ago. A case series of nine children whose parents consented to the developing technique is presented with follow-up ranging from months to years, along with technical descriptions and illustrative drawings. None of these cases had preoperative orthopedic correction, molding, or postoperative nostril splints. The esthetic outcome was optimal enough; none of the cases requested a secondary correction.ConclusionThe nasal cantilever technique is a novel concept in cleft nasal deformity, which can be used in conjunction with an appropriate lip technique, per the surgeon’s discretion. Other than a learning curve, we believe that it provides a solid correction by securing the cartilaginous structures after they have been mobilized to a stable base, the nasion.

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Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results

Facial Plastic Surgery ◽

10.1055/s-0041-1726025 ◽

2021 ◽

Author(s):

Juliano de Oliveira Sales ◽

Wolfgang Gubisch ◽

Rodrigo Ribeiro Ferreira Duarte ◽

Aline Souza Costa Teixeira Moreno ◽

Felipe Marques de Oliveira ◽

...

Keyword(s):

Patient Satisfaction ◽

Age Groups ◽

Functional Results ◽

First Year ◽

Lateral Cartilage ◽

Lower Lateral Cartilage ◽

Alar Retraction ◽

Outcomes Evaluation ◽

A New Technique ◽

Extension Graft

AbstractHere we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.

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